Dog Adoption Application - Catawba Humane

Please list the Pet Names you're interested in adopting.*

You can add more pets by pressing the plus button.

About you

Name

Are you over 21 years of age?*

Yes
No

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number

Email*

Employer

Work Phone

Please list your driver's license number.

Your history with pets

Have you ever adopted a pet from Humane Society of Catawba County before?*

Yes
No

Do you still have this pet?*

Yes
No

What happened to the pet?

Have ever surrendered a pet before?*

Yes
No

Please explain the decision to surrender a pet.*

Are you willing to reach out before surrendering a pet back to HSCC for suggestions?*

Yes
No

More about your family

Are you adopting a dog for*

Yourself
Family
Gift
Relative
Children

Do all members of your household want a new pet?*

Yes
No

List any additional people your new dog will be living with (Specify the age of children)

Name	Age	Relationship

You can add more people by pressing the plus button

What will happen to this dog if you move?

Are any members of your household allergic to

Cats
Dogs

More about your home

Do you own your residence?*

Yes
No

Do you have a fenced in yard?*

Yes
No

If renting does your landlord allow dogs?*

Yes
No

Landlord's Name

Landlord's Phone

Where will the dog live?

Inside Only
Outside Only
Inside / Outside (Explain)

Please explain your previous answer

Where will this pet be kept when you're not at home?

Inside
Basement
Garage
Crate
Tied Outside
Other

Please provide details for your previous answer

Are you willing to give the pet 30 days to adjust to the new environment?*

Yes
No

Please list the pets currently living in your home

Name	Cat/Dog	Breed	Age	Do you still have this animal? If no, explain.	Spayed or Neutered?

You can add more animals by pressing the plus button

List the office name and phone number of your current veterinarian

What specific characteristics/traits are looking for in your adopted pet?

With my signature below, I signify I understand that:

I am 21 years of age or older.
I will provide food, shelter, medical care, love and affection for the lifetime of this animal, which could be as long as 20 years or more.
I agree to take this animal to a Veterinarian for exams and vaccines at least once yearly and as needed, and to provide vet care, at my own expense, should this animal become ill or injured.
I cannot sell, transfer, trade, give away, or lease the adopted animal to any person or organization without first notifying HSCC.
HSCC makes no representations or warranties regarding the health, size, or temperament of the animal being adopted hereunder, and HSCC expressly declaims the same.
I agree to hold harmless HSCC, its staff, directors, agents, and representatives for any and all claims, losses, and damages, whether to the person or property, which might arise as a result of the subject animal’s health condition or behavior.
This application remains the property of HSCC.
I am stating that the above information is true.
By signing below, I authorize agents of HSCC to contact my previous veterinarians to receive medical records for my pets.

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